- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $949.23 / $9,062.00 / $18,276.00
| Facility | | $949.23 | $9,062.00 | $18,276.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,902.15 / $8,872.27 / $20,484.25
| Facility | | $3,902.15 | $8,872.27 | $20,484.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $715.00 / $943.36 / $5,740.31
| Facility | | $715.00 | $943.36 | $5,740.31 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $93.69 / $93.69 / $93.69
| Facility | AS | $93.69 | $93.69 | $93.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.85 / $1,148.57 / $1,808.83
| Facility | | $912.85 | $1,148.57 | $1,808.83 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $137.36 / $164.92 / $239.84
| Facility | AS | $137.36 | $164.92 | $239.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,912.00 / $16,223.00 / $23,485.00
| Facility | | $2,912.00 | $16,223.00 | $23,485.00 |